Project ECHO: Cervical Cancer Prevention

The Cervical Cancer Prevention Project ECHO (CCP) was developed to address high rates of cervical cancer in low-resource areas of Texas. These ECHO sessions bring together advance practice providers and physicians from underserved regions in Texas and physicians in low and middle income countries to discuss clinical guidelines and best practices for cervical cancer prevention.

The Cervical Cancer Prevention teleECHOTM, the first ECHO program at MD Anderson, is a partnership with MD Anderson, The University of Texas Medical Branch (UTMB), The University of Texas Health Science Center-Houston (UTHSC-H), The University of Texas School of Public Health (UTSPH) in Brownsville and Su Clinica Familiar, which is a Federally Qualified Health Center (FQHC) in the Rio Grande Valley. The program has grown to include faculty and participants from UT-Rio Grande Valley Medical School, mid-level providers in Houston, community clinics in Laredo and providers in Mexico, El Salvador, Guatemala and Brazil.

There are more than 530,000 new cases of cervical cancer and 275,000 related deaths annually worldwide. More than 85% of cases occur in low- and middle-income countries, where cervical cancer is the 1st or 2nd leading cause of cancer death among women. It is now known that virtually all cases of cervical cancer are caused by persistent infection with high-risk types of the human papillomavirus (HPV). Preventive vaccines are commercially available and are recommended for girls and boys between the ages of 11 and 12 before the onset of sexual activity yet, only 30% of children in the US have completed the three vaccine series thus, secondary prevention via cervical cancer screening, diagnosis, and treatment will remain necessary for the foreseeable future.

In the United States, cervical cancer incidence and mortality rates have decreased by approximately 70% over the last 40 years due to implementation of screening programs based on Papanicolaou (Pap) and more recently human papillomavirus (HPV) testing. However, medically underserved areas in the United States and globally have been unable to achieve this same success in reducing the burden of cervical cancer due to a lack of effective, high-coverage screening programs, limited public education, and a shortage of locally available trained personnel to perform the diagnostic procedures and treatments recommended for patients with abnormal screening tests.

In addition, many women with positive screening tests do not receive the recommended diagnostic and treatment procedures, as they are unable to travel to central healthcare facilities for the multiple necessary follow-up visits due to the long distances and high costs associated with travel.

Data from the Texas Cancer Registry shows that women residing in the four counties in the Lower Rio Grande Valley along the Texas-Mexico border (Hidalgo, Cameron, Starr and Willacy) have a higher incidence of cervical cancer and cervical cancer mortality compared with non-border counties. Ninety percent of this population is Hispanic, 35% are living below the federal poverty line, and the majority do not have health insurance. There are currently no public hospitals serving the region and there are 40-50% fewer physicians and nurse practitioners per 100,000 people compared with the Texas average. As a result, there are limited screening, diagnostic and treatment services available for cervical cancer prevention in this population.

This program, initiated in 2014, is funded by the Cancer Prevention Research Institute of Texas (CPRIT). This is a collaboration between UTMB, UTHSC Houston, UTSPH Brownsville and Su Clinica Familiar, a FQHC in the border region of South Texas. Today, this program includes the UTRGV Medical School, two clinics in Laredo Texas, and the social security hospital in Matamoros, Mexico. The goal of this program is to continue to expand to other low resource regions in Texas and to partner with other institutions in the University of Texas system.